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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Prem Narain, Presiding Member
Sushila Kumari —Petitioner
versus
LIC of India —Respondent
Revision Petition No.3606 of 2011
(Against the Order dated 30/05/2011 in Appeal No. 376/2008 of the State Commission Haryana)
Decided on 28.3.2018
Counsel for the Parties:
For the Petitioner:Mr. Sanchar Anand, Advocate
For the Respondent:Mr. Rajesh K. Gupta, Advocate
IMPORTANT POINT
Order repudiating the claim without valid reason is liable to be set aside.
Headnote:Consumer Protection Act, 1986—Section 17—Petitioner’s husband obtained 3 policies from the respondent company—On 3.2.2004, the insured expired due to sudden heart attack—Petitioner claimed the insurance amount which was not paid by the respondent company—Hence, complaint was filed for recovery of the amounts covered under three policies amounting to Rs.5,00,000/-; Rs.50,000/- and Rs. 50,000/- within three months failing which interest @ 9% has to be paid—Appeal was filed by the respondent company which was allowed by the State Commission—Hence, the present revision—Respondent contested that the insured did not disclose his health conditions due to which the respondent repudiated the claim—No proof was filed by the respondent that the insured withheld information regarding his health—Perused the documents—Heard the counsels—It is held that having failed to produce proof that the insured has withheld his health conditions at the time of taking policy, respondent cannot repudiate the claim—Hence revision is Commission is set aside upholding the orders of the District Forum—The respondent has to pay the amounts with interest @5% p.a.—It was further held that the respondent company is at liberty to file criminal and civil case against the Insured L.R’s for suppressing health condition. No compensation and costs are awarded.
Result: Revision allowed upholding the orders of the District forum and orders of the State Commission is set aside.
This revision petition has been filed by the petitioner Sushila Kumari against the order dated 30.05.2011 of the State Consumer Disputes Redressal Commission, Haryana (in short ‘the State Commission’) passed in First Appeal No.376 of 2008.
2. Brief facts of the case are that on 24.04.2003 , Ram Niwas, late husband of the revisionist obtained life insurance policy No.173485821 and policy No.173485822 for a sum of Rs.5,00,000/- and Rs.50,000/- respectively from the respondent. On 28.07.2003, Ram Niwas, late husband of revisionist obtained life insurance policy No.173489970 for a sum of Rs.50,000/- from the respondent. On 03.02.2004, Ram Niwas, the insured expired due to sudden heart attack. On 17.03.2005, since inspite of the revisionist submitting all claim documents and completing all formalities, the respondent failed to make payment of the insurance policy to the complainant. Therefore, the present revisionist filed the complaint No.92 of 2005 against the respondent before District Consumer Disputes Redressal Forum, Hisar (in short ‘the District Forum’). The District Forum passed the following order vide its order dated 14.12.2007:-
“7. So in view of the abovesaid discussion, we are of the considered view that it is a clear case of gross deficiency in service and negligence on the part of the respondent corporation. Therefore, there is merit in this complaint which is hereby accepted. The respondent corporation is hereby directed to pay the sum assured i.e. Rs.5.00 lacs (Rupees five lacs) under policy No.173485821; Rs.50000/-(Rupees fifty thousand only) under Policy No.173485822; Rs.50000/- (Rupee fifty thousand only) under policy No.173489970 to the complainant. Compliance of this order be made within the period of three months; failing which the respondent corporation would be liable to pay interest @9% per annum over this amount from the date of default till its payment. There is no order as to costs and compensation. A copy of this order be supplied to both the parties free of cost as required Sub rule 10 4 of the Haryana Consumer Protection Rules, 1988. File be consigned to the record room after due compliance.”
3. Aggrieved by the order of the District Forum, the opposite party preferred an appeal bearing No.376 of 2008 before the State Commission and the same was allowed by the State Commission vide its order dated 30.05.2011 and the order of the District Forum was set aside.
4. Hence the present revision petition.
5. Heard the learned counsel for both the parties and perused the record. Learned counsel for the petitioner stated that the husband of the petitioner/complainant had taken three life insurance policies bearing No.173485821 dated 24.4.2003 for Rs.5 lacs, Policy No.173485822 dated 24.4.2003 for Rs.50,000/- and Policy No.173489970 dated 28.7.2003 for Rs.50,000/-respectively. The policy holder died on 03.02.2004. The claim was preferred by the complainant. However, three insurance claims were repudiated by the Insurance company vide three repudiation letters dated 17.05.2005, 17.05.2005 and 28.06.2005 on the ground that Deceased Life Assured (DLA) had withheld the information in respect of his health as he was suffering from cancer and he did not disclose this fact in the proposal form. Wife of the DLA has filed the complaint before the District Forum and the District Forum has allowed the complaint on the ground that the Insurance Company could not prove that the DLA was suffering from cancer.
6. It was stated by the learned counsel for the petitioner that Insurance Company then preferred an appeal before the State Commission. Though the State Commission has agreed with the finding of the District Forum that no evidence has been produced by the Insurance Company to prove that the DLA was suffering from cancer and that this information was withheld in the proposal form, yet the State Commission has relied on forensic report filed by the Insurance Company which was filed for first time before the State C
